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Continuous renal replacement therapy in children after cardiac surgery
Maria José Santiago1, Jesús López-Herce, Javier Urbano
1Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Insights
Children needing continuous renal replacement therapy (CRRT) after heart surgery face high mortality. Hypotension upon initiating CRRT is the primary risk factor for death in these critically ill pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Nephrology
Background:
- Continuous renal replacement therapy (CRRT) is used for acute kidney injury in critically ill children.
- Cardiac surgery is a significant cause of acute kidney injury in pediatric patients.
Purpose of the Study:
- To investigate the clinical outcomes of children requiring CRRT post-cardiac surgery.
- To identify factors associated with mortality in this patient population.
Main Methods:
- A prospective observational study compared children on CRRT post-cardiac surgery with other critically ill children on CRRT.
- Univariate and multivariate analyses were employed to determine mortality predictors.
Main Results:
- 4.9% of pediatric cardiac surgery patients required CRRT, with 80.2% experiencing multiorgan failure.
- CRRT patients post-cardiac surgery had lower blood pressure and renal function markers, and higher ventilation needs.
- Mortality was 43% in the cardiac surgery group versus 29% in others (P=.05).
- Hypotension at CRRT initiation was the sole independent predictor of mortality (HR 4.01).
Conclusions:
- Pediatric patients requiring CRRT after cardiac surgery have a high mortality rate.
- Hypotension is a critical, modifiable factor linked to increased mortality in these children.
Objective:
The objective was to study the clinical course of children requiring continuous renal replacement therapy (CRRT) after cardiac surgery and to analyze the factors associated with mortality.
Methods:
A prospective observational study was performed that included all children requiring CRRT after cardiac surgery, comparing these patients with other critically ill children requiring CRRT. Univariate and multivariate analyses were performed to determine the influence of each factor on mortality.
Results:
Eighty-one (4.9%) of 1650 children undergoing cardiac surgery required CRRT; 65 of them (80.2%) presented multiorgan failure. Children starting CRRT after cardiac surgery had lower mean arterial pressure and lower urea and creatinine levels, and were more likely to require mechanical ventilation than other children on CRRT. The incidence of complications was similar. Cardiac surgery increased the probability of requiring CRRT for more than 14 days. Mortality was 43% in children receiving CRRT after cardiac surgery and 29% in other children (P = .05). Factors associated with mortality in the univariate analysis were age less than 12 months, weight less than 10 kg, higher Pediatric Risk of Mortality Score, hypotension, lower urea and creatinine on starting CRRT, and use of hemofiltration. In the multivariate analysis, the only factor associated with mortality was hypotension on starting CRRT (hazard ratio, 4.01; 95% confidence interval, 1.2-13.4; P = .024).
Conclusions:
Although only a small percentage of children undergoing cardiac surgery required CRRT, mortality in these patients was high. Hypotension at the time of starting the technique was the only factor associated with a higher mortality.
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